Organization
CULTIVATE PSYCHOLOGICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELLY JEAN FARNAN PSY.D. (LICENSED PSYCHOLOGIST/OWNER/MEMBER)
(417) 619-9818
Entity
Organization
Contact information
Practice address
1439 S ROGERS AVE, SPRINGFIELD, MO 65804-1129
(417) 619-9818
Mailing address
331 E WATER ST, SUITE 107, SPRINGFIELD, MO 65806-1141
(417) 619-4466
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2009030819
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962737734
—
MO
01
—
MA1019011
MEDICARE I.D. NUMBER
—
Enumeration date
05/16/2012
Last updated
05/16/2012
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